Elderly warned to stop taking common cure all

Henry Herrera

They concluded that among patients aged 75 or older, the overall risk of developing serious bleeding was 10 times higher - which the authors concluded was "at least as likely to be disabling or fatal" as another stroke.

To TCTMD, Gurbel noted that the estimated number needed to treat (NNT) to prevent one upper gastrointestinal bleeding event at 5 years was 23 for patients aged 75 to 84 years and 21 for patients 85 years and older. "But our new study gives us a much clearer understanding of the size of the increased risk and of the severity and consequences of bleeds", said Professor Peter Rothwell, the study's lead author.

While the stomach bleeds can be potentially prevented by taking stomach-protecting PPI pills, taking daily aspirin in older people after a stroke or heart attack is still essential, and stopping aspirin use suddenly could be unsafe, according to the BBC. They also warn that stopping aspirin suddenly (for those who have been taking it regularly) could have some complications.

Worryingly, this advice was based on trials involving younger patients for just two to four years. The study covered a time frame of 10 years and recorded 314 study subjects who were admitted to the hospital on the account of bleeding.

The people aged over 75 are at higher risk of stomach bleed but the risk can be prevented by taking PPIs along with aspirin. For patients aged under 65, the annual rate of life-threatening or fatal bleeds was less than 0.5 percent, but for patients aged 75-84, the rate rose to approximately 1.5 percent. But doctors have been reluctant to add another drug to an elderly person's typically long list of medications, and the practice of viewing aspirin-related bleeds as minor also means that the risks of bleeding aren't being addressed properly.

The chances that bleeding was disabling or fatal, while lower, increased in roughly the same amounts equally across the different age groups. The second effect of (the) study is its support for the need to use PPIs in patients on antiplatelet therapy aged 75 years or older or in patients with a history of gastrointestinal bleeds.

Because the majority of patients studied were taking low-dose aspirin, rather than more modern anti-platelet drugs such as clopidogrel or AstraZeneca's Brilinta, the study could not draw conclusions about combined drug use. A daily aspirin dose of 75 mg is usually prescribed in both the US and Europe to prevent heart attacks or strokes.

"The second outcome of (the) study is its support for the need to use PPIs in patients on anti-platelet therapy aged 75 years or older or in patients with a history of gastro-intestinal bleeds".

But experts say the risks needed to be evaluated. For the patients who are under 65, the hospital admissions due to the bleeding are 1.5 percent.

But "the new data should provide reassurance that the benefits of PPI use at older age outweigh the risks".

Those without a history of heart attack or stroke should avoid taking aspirin as they got older, he suggested.

"It is clear from the data presented that, in the over-75s, taking PPI along with aspirin was associated with a reduced likelihood of bleeding", said Tony Fox, a professor in the Pharmaceutical Medicine Group at King's College London.

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